Coffee & Conversation in a smoky room

A Clinic RN and a Single Mom blogging through the depths of sanity. My life as I know it started with coffee and conversation in a smoky room. This is where I'm at now.

Jun 29, 2008

Good Bye

Dear Reader,

I am no longer Blogging. You are welcome to stay and read my previous posts, I hope you find them entertaining/interesting/informative.

My reasons to quit Blogging are varied...... I simply have no time, I have nothing to say, I'm an RN working in a close nit clinic and there could be privacy issues, also I'm in a different place in my life right now and simply don't need the blog like I used to.

I've made a few friends doing this blogging thing, and I still visit their sites from time to time. Check out my links to see who I read.

Nov 16, 2007

H.R. 4138

The kiddo is home sick today with a stomach bug. So I thought I would take some time to blog, seeing as I have not had the chance in the past few weeks. My friend Beth over at PixelRN called my attention to a bill in congress that could be a really good thing for the Healthcare industry.H. R. 4138 is sitting in congress and if it passes, it could enable the Nursing Staff in Hospitals across the country to determine staffing for their very own units.I hate to sound cynical but I see Hospitals finding some loophole to get around it if it passes. (i.e. Like hiring one RN to oversee staffing and pressuring that RN to staff scarcely) However, whether it passes or not, it still calls attention to the biggest problem with hospital nursing and could save lives by preventing mistakes, med errors, and give nurses the opportunity to do more of what they do best....caring. Staffing was part of the reason I left Hospital Nursing. I simply just couldn't do the whole being responsible for 6 patients when more then 3 of them were total care. It's not safe. Nurses burn out. Hospitals don't seem to get that if they staff well, they lose fewer nurses, therefore saving them money in the long run that they spend on orientation and training.I hope this Bill passes. But even if it doesn't, it's mere existence is a step in the right direction.

Unfortunately, these patients are finding this information off of crackpot sites or they are misinterpreting the info off of legit sites because they have no medical background and they don't understand what they are reading.

Even if you've found information stating "blah blah blah is best for people with this disorder" That doesn't mean it's best for you.

The phrase "consider the source" comes to mind when these patients call but I remain open-minded because I believe it is always possible they they may have come across some information that might actually help them.

My Doctor is ever so gracious about the info. She actually reads the print-outs her patients bring her but usually sticks by her treatment plans because they actually work. She will tell them to go seek a second opinion from another doctor without hard feelings if the patient is persistent with the new "idea", "drug", or "procedure." She will go to Endocrinology conferences and come back and change her protocols. She's not closed to new ideas or research.

A search through Google for "Thyroid Disorder" produces interesting results. The number one result was the article "Oprah reveals Thyroid trouble" ......gee...didn't see that coming.

Oct 1, 2007

Overtime and Cold Meds

Job still going well! I've never worked this much overtime before. The days fly by and it's 5pm then 5:30pm and I'm trying to finish up and get the heck out of there. But there's always one more Refill request to Fax, one more patient to call, one more lab result to look up.

I worked through lunch today, with my doctor frowning and and commenting that the reason I worked through lunch was because she went out of town last week. It's all good though. I was OK with it. I like doing what I'm doing and it made me feel better to get a few extra charts off my desk today. I'm like Earl and I believe in Karma...it'll pay off.

**************

There's this new buzz about cold medicine and kids going around. Here's an article.

Personally, I have given my daughter doses of cold medicines and antihistamines in her little lifetime. They worked. She started having pollen allergies at age 3 and if we didn't/don't nip them in the bud early she develops a sinus infection. She still takes prescribed Nasonex so it eliminates the need for Benadryl or Robitussin.

I think the main issue...the biggest problem is that parents are giving these to their young kids without the knowledge of proper dosing (By Weight...not age). They aren't seeking the advice of their doctors or they aren't understanding the instructions. It could be they just don't have the money to have a Primary Physician (pediatric or family practice) and just guess the proper doses when the kiddos get sick.

Either way, what will happen is they'll just take the infant stuff off the market and the children's stuff will advise NOT to give to a child 6 and under.

This is good news for the pharmaceutical companies who provide the prescribed stuff. That's where all that money is gonna shift.

I posted a little about this over at Nursing Voices. If you want to add your comment.

Sep 21, 2007

Nursing voices/Jobs

I just want to post again about the contest over at Nursing Voices . You see, it's a Nursing Forum where Nurses and other people of the medical profession cal leave messages for each other about Nursing stuff and others. There's different categories to post under so it doesn't have to be specific to just nursing. The highest post this month (Until Oct 15th) and those who make mention in their blogs wins an iPhone. A second iphone goes to the person who named the winner (Hopefully me! ha ha) as the person who referred them. So tell them I sent ya!Now for you nurses out there looking for jobs, a good resource would be to head over to NursingJobs .It's worth a look!

Work, Kid, and iphone!

Work is getting better. Next week, My Doctor is out of town and my fellow RN is taking time off so I get to run the helm by myself for 4 days next week.

I expressed some ahem...anxiety to Doctor about this seeing as I've only been there a little more then a month and I'll be doing treatments, seeing follow up patients, and answering all calls.She's given me all her numbers...cell, pager...and has encouraged me to text message her with any small questions.

I hope I do OK.

Ari's doing better about school and she's getting adjusted to the idea that this whole school business is not an option or temporary.She's been getting reprimanded a lot more then last year for "Not paying attention or talking".They use the Green light system where they have a clothespin on on Green at the beginning of the day and it can be moved to Blue(OK), Yellow(OOPS), Orange(Uh OH), Purple (Trouble) or Black (BIG Trouble).She's averaging around green and blue and has gotten to Yellow once. A report is sent home daily but she's been honest with me about her "color" when I pick her up.Another adjustment she's made has been homework. She didn't have any last year besides reading assignments that we could do at our leisure but this year she has daily homework all due on Friday and it;s been hard to get her to sit down and do it all.

Sep 18, 2007

too many sick people

I'm so exhausted today! I came in 15 mins early, only had time for a 30 min. lunch and left 45 mins late and me and my fellow office nurse STILL had stacks and stacks of charts on our desks.I even offered to pick up my daughter and bring her back to the office with me to get ahead a little but my boss told me to go home.I honestly think my Doctor has too many patients....and we don't have the man power to cover them all.Also, I've noticed that the Endocrinology/Hormone biz has the highest maintenance type patients. I spent an hour on the phone today with just one couple....sorting out their issues with this and that.*********Daily reminder.......

Sep 17, 2007

Sony ImagePOO

I'm Mad! Sony Imagestation.com is shutting down in Feb. I have all my pictures on there! That's how I print them, buy gifts, and send them out to my friends and family in one convenient place!They have a deal with Shutterfly for transfer so I guess that's what I'm gonna have to do.Still stinks though because I had them all arranged into cute little albums and stuff. :(

Boston Legal -James Spader****House -Hugh Laurie ~ He won last year....I hope he wins again just to hear his speechRescue Me -Denis LearyThe Sopranos -James Gandolfini (Do these guys have to win EVERY YEAR?)*****24 -Kiefer Sutherland ~ I'm torn, I love this character

Outstanding Lead Actress In A Comedy Series

Desperate Housewives -Felicity HuffmanThe New Adventures Of Old Christine -Julia Louis-Dreyfus*****30 Rock-Tina Fey ~ I don't like the show much, but I like herUgly Betty - America FerreraWeeds - Mary-Louise Parker (I thought this was a drama??)

(Side note....Notice how many former 80s TV/movie stars are in the line up?? weird)

Outstanding Supporting Actor In A Drama Series

Boston Legal • William Shatner as Denny Crane (Capt Kirk is in a show now? How did I not know this?) Grey’s Anatomy •T.R. Knight as George*****Heroes • Masi Oka as Hiro Nakamura~ Really crossing my fingers for this lil guyLost •Michael Emerson as BenLost • Terry O’Quinn as John LockeThe Sopranos • Michael Imperioli as Christopher Moltisanti

Outstanding Supporting Actress In A Comedy Series

*****My Name Is Earl •Jaime Pressly as Joy Turner ~ I actually know people like this character *****The Office •Jenna Fischer as Pam Beesly ~ I want them both to winTwo And A Half Men • Holland Taylor as Evelyn HarperTwo And A Half Men •Conchata Ferrell as BertaUgly Betty •Vanessa Williams as Wilhelmina SlaterWeeds •Elizabeth Perkins as Celia Hodes

Outstanding Supporting Actress In A Drama Series

*****Brothers & Sisters • Rachel Griffiths as Sarah Whedon ~ Don't really care much in this category, but I loved her in 6 feet under so I vote for her Grey’s Anatomy • Katherine Heigl as Isobel “Izzie” Stevens

If you are wondering why my picks snub the favorites to win like the Sopranos and Entourage...I personally think the Cable channels should have a category of their own. They're allowed more freedom then the network channels. So those are my picks if I were running the Emmys. :)

[ UPDATE: WOW! Only one of my picks won. Jaime Pressly from "My name is Earl". I knew the Sopranos would probably sweep it. But James Spader??! Really??!!]

Culture shock & Nursing Voices

There's something of a culture shock with my new job.I'm learning to get used to working with patients with insurance and money.None of that at the hospital I worked at before. I'm having a hard time with my compassion meter when the housewife soccer Mom with the Husband, Lexus, 2 perfect kids from the nice side of town calls me to complain that her Thyroid medicine is not "high enough" for her to keep the pounds off and that she's OK with the heart palpitations and insomnia if it means she won't get fat. I just have a hard time not thinking about my former homeless patients with nothing who were just trying to keep their kidneys working or their lungs moving. I keep my mouth shut and feign sympathy. I still like it though...way better then other patients throwing punches at you!

Calling all Nurses, Student Nurses, Wannabe Nurses, or People who just like Nurses!I have it linked on the sidebar!I've been spending a lot of time there lately!

If you want to meet a great group of nurses and you are in the medical field (or just want to hear what nurses have to say)Then check out the Nursing Voices Forum!

Hey Nurses! if ya got the time, also check out NursingJobs.org to find that dream position you've been waiting for. OR... Maybe....just to tweak your resume, check out a great deal on Danskos, or just read a good article. I checked out this site in great detail when I decided to leave the Hospital.I do love the forum, it's picking up steam with posts and I haven't been apart of something like that since shortly after Mike died. Then...I was a regular on a young widows site. I felt I had to move on from there. No Reason to do that at Nursing Voices though! Great group of gals over there, lots who are fellow bloggers as well.

If you decide to register and join, please tell em Jo over at Coffee and Conversation sent ya! (Yeah...there's sorta a contest goin on....shameless maybe.....but the prize is an iPhone! Oh and a second iPhone will be awarded to the person who registers and says I referred them IF I win....sweet! )

Sep 11, 2007

Patriot day- 6 years

I went back a year and read again my post from last year paying tribute to one man lost at the WTC on 9/11. It's one of my better posts and I thought I would repost it again.......to remember.***************From 9/11/2006:***************

When I volunteered to write with 2996 on Sept 11, I had no idea how difficult it would be. I researched my assigned person, Gregory T. Spagnoletti for weeks.I found out a little bit about this man who suffered a terrible fate when the World Trade Center was attacked and collapsed in NY city.

I think the best way to pay tribute to him is to share with you what I found out.

He had a great smile.

His friends called him "Greg" or "Spags".

He worked for Keefe, Bruyette, and Woods as a Bond Salesman.

He was the 3rd Brother of Four.

They were all big hockey Fans.

He organized hockey games at Chelsea Piers.

Out of the 4 Brothers, he was called the "responsible" one.

He was known for dropping in to have coffee with his tailor.

He was engaged to be married to Gretchen Zurn.

They had just fixed up their new Apartment on West 72nd st, and he was very proud of it. His family said it would take him 45 minutes to give you the tour of all 1200 sq. feet.

His parents started the Gregory T. Spagnoletti Memorial Foundation. You can donate to it by sending to:Gregory T. Spagnoletti Memorial Foundation 62 Wolff StreetWaterbury, CT 06708

But the biggest thing I found out about Greg was that this man was definitely loved. He is definitely missed.

He like all Americans had no idea as he got up and went to work 5 years ago that America was going to change that day. He had no idea that those 2 towers, which have represented the NYC skyline for 30 years, could ever possibly be brought down by terrorists. Those Towers would become his tomb. He was on the 89th floor of the South Tower when it went down. It took officials almost 2 years to identify some remains and return them to his family for burial.

Greg,Five years ago I can say I was thinking about you as I watch the towers collapse on TV. But mostly I was thinking about Gretchen and the future she had lost with you. I was thinking about the children she would never have with you. I knew you were in a better place but I knew all too well the horrible place your loved ones were in. I prayed that God be with them on that day. I want you to know that America won't forget what happened what happened to you and 2995 other innocent people.

To my readers,

Please visit 2996 to find links to 2996 bloggers who have paid tributes to the victims of 9/11.

Luckily, the nurse I'm replacing (she left the position to go part-time float for school) was able to fill in for triage and was there to answer any questions that might pop up.

Things got sticky when my Doctor ordered an injection for a patient and I had no idea where we kept the supplies or drugs. At the same time I had 4 people in our waiting room waiting to be shown to a room (a lot for us). Prior Nurse saved me there too, she showed me where the supplies were and offered to give the shot while I got the patients into rooms.

At least I know I can do it now, and I'll be more comfortable next time.....but talk about being thrown to wolves.

And the AC was fixed by 10am....which was nice.

******Ari's having some real anxiety with first grade. Once this week while dropping her off, she refused to get out of the car. I had to park and coax her out, walk her to class. The next few days she was sick, with one day she was actually....really sick (A sinus infection with psuedo-pinkeye...the eye I think was irritation from the sinuses). The other days I think she was milking it.

I asked her what was wrong with school, she says that it's boring and not as much fun. That they are working too hard.

I kind of expected this shock with 1st grade, it's not Kindergarten fun anymore. I just didn't think she'd be so stubborn about it.

She's trying to convince me to be a stay at home mom and home school her. Not gonna happen.

Sep 3, 2007

Mike

I've decided since I won't be writing about anonymous patients anymore that it would be generally safe to post pictures of me here.

This pic is from a happy time...we were young, healthy (way thinner), and happy. 1995... Just about to get married so that the Air Force would ship me where ever he was stationed. Which turned out to be right next door in icky, yucky, smelly Shreveport,LA.

It'll be 6 years since he died...tomorrow. I still think about him everyday.

Aug 27, 2007

Clinic Nursing

I'm back! At least for an update. I'm not sure if I'll continue posting so I'm sorry to all of you who keep checking in on me....i see you....from my web counter...I do appreciate it.

I quit the Hospital the beginning of August. The hours although not long were just not accommodating for a single mom. I hated getting someone to take Ari to school for me. I hated panicking every time there was a holiday where I was expected to work. I hated the long commute...45 mins to an hour in the am and then the hour to hour 1/2 home.

I left because I accepted the most excellent position working for an Endocrinologist. At first I thought it might be too boring for me but It's sooo busy. It's just me and another Nurse working for this one Doctor. The Doctor is awesome with her patients and is really nice and encouraging so far. But she's very particular with her charting and how things are done. It's almost like learning the routines of an Obsessive compulsive. I know she has her reasons for doing things this way or that but it's sooo overwhelming to learn.

Here's my Hospital vs Clinic comparison for all you new RNs looking for a job.

Hospital:

Longer Hours/ fewer days a week

Holidays...most you have to work or at least rotate

Weekends...typically at least 1 weekend/month but you usually get paid extra

Far better pay, when you consider differentials and bonuses

Using most traditional Nursing skills...the ones we all checked off in RN school

Dealing with patients not in their right mind who may throw something at you

Not having to deal with referrals, financial stuff, and insurance companies

Working at a pace you manage with probably nobody to check to see you are doing what you are supposed to be doing. (it's all honor code at the hospital)

Treating Doctors more like equals and even teaching the baby Docs a thing or two

Patients can have life threatening situations at any time

You can't leave unless you have a nurse to take your patients. It would be illegally abandoning them.

Clinic

Shorter, more human hours but 5 days/week

Most if not all holidays off and usually paid for

All weekends off!

Less pay...unless you stick around awhile and maybe get certified to do fancier things, however... it's easy to work through lunch if you have too much to do and that = overtime

Not using a lot of "Traditional" Nursing skills...injections and a few IVs is basically the best chance

Dealing with patients who may not be in their right mind who might just yell at you over the phone.....or threaten to "take their money and insurance elsewhere"

Having to deal with referrals, financial stuff, and insurance companies...the most annoying part of my new job...hate it.

Working at your doctor's pace and schedule....all else you have to fit in between phone calls.

The Doctor is boss...what they say...goes. Whether it makes sense or not.

Life threatening situations RARELY happen in a clinic....especially mine.

You can leave....for appointments, to pick your kid up, etc. My fellow co-worker brought hers in today just to color at her desk while she worked.

It's still chaos...just a different kind of chaos.

So....... with Ari starting 1st grade (waaa...she's getting too big!) this week, it's been really great to drop her at school and know....if anything happened to her, it wouldn't be illegal or a threat to my license to drop everything at work and go get her.

So, with me being in a clinic setting I won't be able to post much about patients...too easy to figure out with a close nit setting like that. But I'll try to pop in and post every once in awhile with updates.

Mar 23, 2007

A huntin' I will go

I've been hinting around now for awhile about looking for a new job. I am getting serious about it and I plan to revamp my resume and actually start putting it out there in the next few months. The reason I haven't yet is because I am a woman of my word....I signed up for one year in my current position and I owe my fabulous boss at least that much.

It all just boils down to the hours. When I'm working even until 3, I still have to "work" when I get home taking care of a kindergartner. I want to be able to take her to school in the mornings, spend holidays, and weekends with her. Basically, I just want to work when the rest of the country does.

Mar 6, 2007

Slackers

Wow. I'm such a slacker. One month since my last post. I'm truly sorry to those who have checked by in the past month unrewarded.

It's been busy. Working, Girl Scouts with Ari, Gymnastics with Ari. Ari was pretty sick there for a week with a nasty case of Strep that had even caused a rash. She happens to be home with tummy troubles today too.

I've gotten lucky the last 2 weeks at work. I haven't had the worst patients on the floor. (by worst, I mean crazy and hostile)

Now this week I did have some heavy patients on the floor but I had students with me. Thank God for students! I don't understand why some nurses don't like students. I love teaching and it's fun to show them the tips I've picked up. And how can you not love having an extra set of hands, especially in nursing?

Recently at shift change I called another CRT on my patient. Physical Therapy had been moving my CVA (Stroke) patient and when they got him back to bed he became unresponsive and started breathing in the style of "Cheyne-Stokes". (It's always when they're moved) Since he was still breathing I called the CRT.

I was very pleased the student I had with him stayed late for the whole process to help me answer questions to the CRT team and the MD. With both of us answering their questions we had him in the ICU within the hour. Not a slacker.

The most frustrating thing about that CRT was that the MD I had been communicating with all day passed the buck off to another MD when he heard his patient was crashing. The new MD (who is one of our own...we all love him) walked in knowing nothing about the patient. The original MD.....Slacker.

I'm not sure why my unit has been slammed with all these heavy patients lately. We used to be the lightest floor in the hospital. The problem is we staff for a "light" load. 5-6 heavy patients on a day shift is not cool. People are quitting.

This summer, when my contract is up, I may be searching for a different position myself.

Feb 4, 2007

Judgements and ASSumptions

I was thinking the other day about writing a post about the judgements nurses and doctors make with patients. I wasn't sure how to lay it all out and coincidentally came across Third Degree Nurse's post about a similar subject.

I've heard a lot of comments in the past about what patients do to put themselves in the hospital.

"Why do these people drink themselves to death"

"He has COPD but thinks it's OK to keep smoking"

"A 40 yr smoker...what did she think would happen?"

"He has Diabetes but he won't follow the diet"

"She weighs 500 lbs, maybe she should've exercised"

"He's been hospitalized 4 times this year detoxing, he doesn't learn"

Even as I watched a liver patient lay there unresponsive and dying I heard an experienced 20 yr nurse say "If he had only stopped drinking..." in front of him.

Maybe it's my personal and family background in addictions that keeps me from even thinking these things. I just don't. When I hear patient diagnoses it doesn't occur to me to think what caused them....just how to care for them.

It's natural for anyone to look for blame....it's human. If we look for a reason it prevents us from doing the same to ourselves. We can tell ourselves that it won't happen to us. Prevention is important.However, it doesn't always apply.When I tell people that Mike died of Oral Cancer, the first question asked is always "did he dip?" (use chewing tobacco). He didn't. Diagnosed at the age of 21....there's not much one could do to cause it....it just happened.

I've met widows of victims of lung cancer who didn't smoke.I know people who are overweight because of their thyroid gland and not because of their eating habits.I've met a few Liver disease patients who never drank.Sometimes it just happens.

On the other hand, there's those who drink because they've had a really hard life. They smoke because it's the only way they know how to cope. They eat too much because they are really sad and depressed.

In Nursing you have to check your assumptions and judgements at the door. A nurse is there to take care of the patients needs now and hopefully teach and encourage the patient to not damage their bodies further....if that is the case.

The trick is to remain compassionate, empathetic, and caring despite what caused the patient to walk in your door. Don't avoid the patient because "he deserves what he caused". And bite your tongue.....I guarantee the patient knows why they are there.

It helps me to remember to never judge a person unless you've walked a mile in their shoes.